Treatment with cholinesterase inhibitors

Currently, the main available treatment of cognitive and behavioural symptoms in AD involves enhancement of cholinergic neurotransmission using cholinesterase inhibitors.³ There are currently three cholinergic-based drugs that represent the standard of care for AD.³ The use of these treatments is supported by the early impairment of the cholinergic system and its strong association to cognitive deficits.³ Cholinesterase inhibitor therapies for AD have generally been considered as short-term interventions with symptomatic effects lasting between 3 and 6 months.³ However, trials suggest that stabilization of symptoms and maintenance of clinical effects for more than one year may be feasible.⁵ Data has demonstrated that long-term effects, for up to 3 years, may be experienced using donepezil, rivastigmine, and galantamine.⁵

References:
1. Hampel H, Mesulam MM, Cuello AC, et al. The cholinergic system in the pathophysiology and treatment of Alzheimer’s disease. Brain 2018; 141 (7): 1917–1933.

2. Gauthier S, Webster C, Servaes S, et al. World Alzheimer Report 2022: Life after diagnosis: navigating treatment, care and support. Available at: https://www.alzint.org/u/World-Alzheimer-Report-2022.pdf. Accessed October 2023.

3. Giacobini E, Cuello AC, Fisher A. Reimagining cholinergic therapy for Alzheimer’s disease. Brain 2022; 145 (7): 2250–2275.

4. Massoud F, Gauthier S. Update on the pharmacological treatment of Alzheimer’s disease. Curr Neuropharmacol 2010; 8 (1): 69–80.

5. Hampel H, Vergallo A, Caraci F, et al; Alzheimer Precision Medicine Initiative. Future avenues for Alzheimer’s disease detection and therapy: liquid biopsy, intracellular signaling modulation, systems pharmacology drug discovery. Neuropharmacology 2021; 185: 108081.